Office visit copayments: patient knowledge, response, and communication with providers.

Background: There is limited information on patients' knowledge about their cost-sharing requirements and how that influenced their care-seeking behavior.

Objective: To examine patients' knowledge of their office visit copayments, their self-reported responses to perceived and actual copayments, and discussions with physicians about costs.

Research Design: Cross-sectional telephone interview study with a 71% response rate.

Subjects: Stratified random sample of 479 adult members of a prepaid, integrated delivery system: equal sample of members with and without a chronic disease.

Measures: Perceived and actual office visit copayment amounts, patient self-reported behavioral responses to copayments, cost discussions with a physician, and patient attitudes about discussing costs.

Results: Overall, 50% of respondents correctly reported their copayment amount, with 39% underestimating and 11% overestimating. Among respondents who reported having copayments, 27% reported delaying or avoiding a visit altogether, or talking to a physician/advice nurse instead of attending an in-person visit because of their copayment. Perceived office visit copayment amounts were significantly associated with self-reported behavior changes (OR, 1.47 per $10; 95% CI, 1.06-2.05). Only 4% of respondents reported talking with their physician about their costs, with 79% believing that their providers cannot help them with their costs, and 51% believing that it is inappropriate to discuss costs with their physician.

Conclusions: Patients have limited knowledge of their office visit copayment amounts, and are changing their care-seeking behavior in response to perceived costs. Moreover, most patients are making these changes without discussing their cost concerns with their physician.